DONOR'S INFORMATION FORM

(THEERTH YATRA - DEVDARSHAN SCHEME)

1. Name :

2. Address in India :

3. Address in Overseas (if applicable) :

4. Telephone No :

5. Mobile No :

6. E-mail address :

7. Additional information, if any :

8. Particulars of amount (Cheque/Draft/Cash) :

9. Draft/Cheque No & date :

Signature

Date :